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A systematic review and meta-analysis of the incidence of psychotic disorders: the distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level

Published online by Cambridge University Press:  22 February 2018

M. C. Castillejos*
Departament of Personality, Assessment and Psychological Treatment, University of Málaga, Campus Teatinos, Málaga, Spain Andalusian Group of Psychosocial Research (GAP), Research group of the Ministry of Innovation, Science and Business of the Junta de Andalucía, code CTS-945. Andalucía, Spain
C. Martín-Pérez
Andalusian Health Service, North East Granada Sanitary District, Clinical Management Unit at Marquesado, Alquife, Granada, Spain
B. Moreno-Küstner
Departament of Personality, Assessment and Psychological Treatment, University of Málaga, Campus Teatinos, Málaga, Spain Andalusian Group of Psychosocial Research (GAP), Research group of the Ministry of Innovation, Science and Business of the Junta de Andalucía, code CTS-945. Andalucía, Spain Biomedical Research Institute of Malaga (IBIMA)
Author for correspondence: M. C. Castillejos, E-mail:



Considering existing knowledge on the relationship between certain environmental factors and incidence rates of psychosis, we carried out a systematic review to provide a broad and updated picture of the incidences of different psychotic disorder subgroups worldwide and how some environmental factors influence these rates.


Studies with original data related to the incidence of psychosis (published between 2000 and 2015) were identified via searching electronic databases (CINAHL, MEDLINE, PSYCINFO, PUBMED, and SCOPUS). Data on the following risk factors were extracted: gender, urbanicity, immigration and socio-economic level. Descriptive appraisals of variation in incidence rates (IR) and incidence rate ratios (IRR), with a 95% confidence interval were calculated. In addition, a meta-analysis was performed to calculate IR pooled by diagnosis group and IRR pooled by diagnosis and gender, urbanity, immigration and socio-economic level, using a random effects model.


We identified 33 reports to analyse. Overall IR per 100 000 persons for non-affective psychoses (IR pooled = 22.53 (16.51–28.54)) were higher than affective psychoses (IR pooled = 7.12 (5.03–9.22)). There was an increase in rates of psychosis in men v. women (IRR pooled = 1.54 (1.37–1.72)), in urban v. rural areas (IRR pooled = 1.64 (1.38–1.95)), in immigrants v. natives (IRR pooled = 3.09 (2.74–3.49)), and in lower socio-economic level areas (IRR pooled = 1.78 (1.43–2.22)).


IR among different psychotic disorders was found to vary depending on gender, urbanicity, and immigration (as most of the previous literature focuses on non-affective psychosis or schizophrenia).

Review Article
Copyright © Cambridge University Press 2018 

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Ahmed El-Missiry, A, Aboraya, AS, Manseur, H, Manchester, J, France, C and Border, K (2011) An update on the epidemiology of schizophrenia with a special reference to clinically important risk factors. International Journal of Mental Health and Addiction 9, 3959.Google Scholar
Aleman, A, Kahn, R and Selten, J (2003) Sex differences in the risk of schizophrenia: evidence from meta-analysis. Archives of General Psychiatry [serial online] 60(6), 565571.Google Scholar
Allardyce, J, Boydell, J, Van Os, J, Morrison, G, Castle, D, Murray, RM et al. (2001) Comparison of the incidence of schizophrenia in rural dumfries and galloway and urban Camberwell. British Journal of Psychiatry 179, 335339.Google Scholar
Bogren, M, Mattisson, C, Isberg, PE, Munk-Jørgensen, P and Nettelbladt, P (2010) Incidence of psychotic disorders in the 50 year follow up of the Lundby population. The Australian & New Zealand Journal of Psychiatry 44(1), 3139.Google Scholar
Bourque, F, van der Ven, E and Malla, A (2011) A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychological Medicine 41(5), 897910.Google Scholar
Boydell, J, van Os, J, McKenzie, K, Allardyce, J, Goel, R, McCreadie, RG et al. (2001) Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. BMJ (Clinical Research Ed.) 323, 13361338.Google Scholar
Burns, J, Tomita, A and Kapadia, A (2014) Income inequality and schizophrenia: increased schizophrenia incidence in countries with high levels of income inequality. International Journal of Social Psychiatry 60(2), 185196.Google Scholar
Cantor-Graae, E and Pedersen, CB (2007) Risk of schizophrenia in second-generation immigrants: a Danish population-based cohort study. Psychological Medicine 37(4), 485494.Google Scholar
Cantor-Graae, E and Pedersen, CB (2013) Full spectrum of psychiatric disorders related to foreign migration: a Danish population-based cohort study. JAMA Psychiatry 70(4), 427435.Google Scholar
Cantor-Graae, E and Selten, J (2005) Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 1224.Google Scholar
Coid, JW, Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M et al. (2008) Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study. Archives of General Psychiatry 65(11), 12501258.Google Scholar
Dean, K and Murray, RM (2005) Environmental risk factors for psychosis. Dialogues in Clinical Neuroscience 7, 6980.Google Scholar
Eranti, SV, MacCabe, JH, Bundy, H and Murray, RM (2013) Gender difference in age at onset of schizophrenia: a meta-analysis. Psychological Medicine 43, 155167.Google Scholar
Hamada, Y, Ohta, Y and Nakane, Y (2006) Epidemiological study of schizophrenia on the Island of Tsushima in Nagasaki Prefecture. Psychiatria et Neurologia Japonica 108(2), 117131.Google Scholar
Harrison, G, Fouskakis, D, Rasmussen, F, Tynelius, P, Sipos, A and Gunnell, D (2003) Association between psychotic disorder and urban place of birth is not mediated by obstetric complications or childhood socio-economic position: a cohort study. Psychological Medicine 33, 723731.Google Scholar
Hart, C, Doherty, DT and Walsh, D (2007) First admissions to inpatient care in Ireland for schizophrenia 1971–2004: trends in age and gender. Irish Journal of Psychological Medicine 24(4), 132139.Google Scholar
Heinz, A, Deserno, L and Reininghaus, U (2013) Urbanicity, social adversity and psychosis. World Psychiatry 12, 187197.Google Scholar
Hickling, FW, McCallum, M, Nooks, L and Rodgers-Johnson, P (2001) Outcome of first contact schizophrenia in Jamaica. The West Indian Medical Journal 50(3), 194197.Google Scholar
Hooker, CI, Gyurak, A, Verosky, SC, Miyakawa, A and Ayduk, O (2010) Neural activity to a partner's facial expression predicts self regulation after conflict. Biological Psychiatry 67, 406413.Google Scholar
Jääskeläinen, E, Juola, T, Korpela, H, Lehtiniemi, H, Nietola, M, Korkeila, J et al. (2017) Epidemiology of psychotic depression – systematic review and meta-analysis. Psychological Medicine 12, 114.Google Scholar
Kelly, B, O'Callaghan, E, Waddington, J, Feeney, L, Browne, S, Scully, PJ et al. (2010) Schizophrenia and the city: a review of literature and prospective study of psychosis and urbanicity in Ireland. Schizophrenia Research 116, 7589.Google Scholar
Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB et al. (2008a) Psychoses, ethnicity and socio-economic status. The British Journal of Psychiatry: The Journal of Mental Science 193(1), 1824.Google Scholar
Kirkbride, JB, Croudace, T, Brewin, J, Donoghue, K, Mason, P, Glazebrook, C et al. (2008b) Is the incidence of psychotic disorder in decline? Epidemiological evidence from two decades of research. International Journal of Epidemiology 38(5), 12551264.Google Scholar
Kirkbride, JB, Errazuriz, A, Croudace, TJ, Morgan, G, Jackson, D, Boydell, J et al. (2012) Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS ONE 7(3), e31660.Google Scholar
Kishida, KT, Yang, D, Quartz, KH, Quartz, SR and Montague, PR (2012) Implicit signals in small group settings and their impact on the expression of cognitive capacity and associated brain responses. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 367, 704716.Google Scholar
Krabbendam, L, Hooker, CI and Aleman, A (2014) Neural effects and the social environment. Schizophrenia Bulletin 40(2), 248251.Google Scholar
Lanier, Y, Sommers, MS, Fletcher, J, Sutton, MY and Roberts, DD (2016) Examining racial discrimination frequency, racial discrimination stress, and psychological well-being among black early adolescents. Journal of Black Psychology 43(3), 219229.Google Scholar
Lasalvia, A, Bonetto, C, Tosato, S, Zanatta, G, Cristofalo, D, Salazzari, D et al. the PICOS-Veneto Group (2014) First-contact incidence of psychosis in north-eastern Italy: influence of age, gender, immigration and socioeconomic deprivation. British Journal of Psychiatry 205(2), 127134.Google Scholar
March, D, Hatch, SL, Morgan, C, Kirkbride, JB, Bresnahan, M, Fearon, P et al. (2008) Psychosis and place. Epidemiologic Reviews 30, 84100.Google Scholar
McGrath, J (2006) Variations in the incidence of schizophrenia: data versus dogma. Schizophrenia Bulletin 32(1), 195197.Google Scholar
McGrath, J, Saha, S, Welham, J, El Saadi, O, McCauly, C and Chant, D (2004) A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 28, 213.Google Scholar
Moreno-Küstner, B, Mayoral, F, Navas-Campaña, D, García-Herrera, JM, Angona, P, Martín, C et al. (2014) Prevalence of schizophrenia and related disorders in Malaga (Spain): results using multiple clinical databases. Epidemiologia e Psichiatria Sociale 15, 111.Google Scholar
O'Donoghue, B, Lyne, JP, Renwick, L, Lane, A, Madigan, K, Staines, A et al. (2016) Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis. Psychological Medicine 46, 13671378.Google Scholar
Omer, S, Kirkbride, JB, Pringle, DG, Russell, V, O'Callaghan, E and Waddington, JL (2014) Neighbourhood-level socio-environmental factors and incidence of first episode psychosis by place at onset in rural Ireland: the Cavan-Monaghan First Episode Psychosis Study [CAMFEPS]. Schizophrenia Research 152(1), 152157.Google Scholar
Pedersen, CB and Mortensen, PB (2001) Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58(11), 10391046.Google Scholar
Petkary, E, Mayoral, F and Moreno-Küstner, B (2016) Gender matters in schizophrenia-spectrum disorders: results from a healthcare users epidemiological study in Malaga, Spain. Comprehensive Psychiatry 72, 136143.Google Scholar
Rivera Martinez, C and Galáz González, C (2002) Incidencia de enfermedades psiquiátricas en el instituto Mexicano del seguro social en San Luis Potosí. = incidence of psychiatric disorders in a governmental health institution at San Luis Potosi, Mexico. Psiquiatría 18(2), 6976.Google Scholar
Rothman, KJ, Greenland, S and Lash, TL (2008) Modern Epidemiology, 3rd ed. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
Saha, S, Chant, D and McGrath, J (2008) Meta-analyses of the incidence and prevalence of schizophrenia: conceptual and methodological issues. International Journal of Methods in Psychiatric Research 17(1), 5561.Google Scholar
Saha, S, Chant, D, Welham, J and McGrath, J (2005) A systematic review of the prevalence of schizophrenia. PLoS Medicine 2(5), e141.Google Scholar
Saha, S, Welham, J, Chant, D and McGrath, J (2006) Incidence of schizophrenia does not vary with economic status of the country evidence from a systematic review. Soc Psychiatry and Psychiatric Epidemiology 41, 338340.Google Scholar
Servaas, MN, Riese, H, Renken, RJ, Marsman, JBC, Lambregs, J, Ormel, J et al. (2013) The effect of criticism on functional brain connectivity and associations with neuroticism. PLoS ONE 8, e69606.Google Scholar
Stijnen, T, Hamza, TH and Ozdemir, P (2010) Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data. Statistics in Medicine 29(29), 30463067.Google Scholar
Taylor, RJ, Forsythe-Brown, I, Mouzon, DM, Keith, VM, Chae, DH and Chatters, LM (2017) Prevalence and correlates of everyday discrimination among black Caribbeans in the United States: the impact of nativity and country of origin. Ethnicity & Health 1, 121. DOI: 10.1080/13557858.2017.1346785.Google Scholar
Tortelli, A, Errazuriz, A, Croudace, T, Morgan, C, Murray, RM, Jones, PB et al. (2015) Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England: systematic review and meta-analysis of incidence rates, 1950–2013. Social Psychiatry and Psychiatric Epidemiology 50, 10391055.Google Scholar
Toshitani, K, Kobayashi, T, Osawa, T, Kato, S, Eto, S and Ojima, T (2006) [Is the incidence of schizophrenia declining?: an investigation of the examination rates in the psychiatric clinics of a medical school hospital and a general hospital]. Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica 108(7), 694704.Google Scholar
van der Werf, M, Hanssen, M, Köhler, S, Verkaaik, M, Verhey, FR, RISE Investigators, van Winkel, R et al. (2014) Systematic review and collaborative recalculation of 133 693 incident cases of schizophrenia. Psychological Medicine 44(1), 916.Google Scholar
van Harmelen, AL, van Tol, MJ, van der Wee, NJ, Veltman, DJ, Aleman, A, Spinhoven, P et al. (2010) Reduced medial prefrontal cortex volume in adults reporting childhood emotional maltreatment. Biological Psychiatry 68, 832838.Google Scholar
van Os, J (2004) Does the urban environment cause psychosis? British Journal of Psychiatry 184, 287288.Google Scholar
Vassos, E, Agerbo, E, Mors, O and Pedersen, CB (2016) Urban-rural differences in incidence rates of psychiatric disorders in Denmark. The British Journal of Psychiatry 208(5), 435440.Google Scholar
Vassos, E, Pedersen, CB, Murray, RM, Collier, DA and Lewis, CM (2012) Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin 38(6), 11181123.Google Scholar
Veling, W, Susser, E, Selten, J-P and Hoek, HW (2015) Social disorganization of neighborhoods and incidence of psychotic disorders: a 7-year first-contact incidence study. Psychological Medicine 45(9), 17891798.Google Scholar
Viechtbauer, W (2010) Conducting meta-analyses in R with the metaphor package. Journal of Statistical Software 36, 148.Google Scholar
Zink, CF, Tong, Y, Chen, Q, Bassett, DS, Stein, JL and Meyer-Lindenberg, A (2008) Know your place: neural processing of social hierarchy in humans. Neuron 58, 273283.Google Scholar
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